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目的探讨乳腺恶性腺肌上皮瘤的病理形态学特点、诊断及鉴别诊断。方法应用光镜观察及免疫组化染色方法对1例乳腺恶性腺肌上皮瘤进行临床病理分析,并复习文献。结果肿瘤由恶性腺上皮和肌上皮两种细胞组成,呈巢团状浸润于增生的纤维间质中;腺上皮胞质红染,位于肿瘤细胞巢中央,排列呈腺管状;肌上皮围绕腺上皮排列于肿瘤细胞巢的周边,胞质透明,核分裂多见,细胞异型明显。免疫组化具有双向性表达特征,两种上皮CK5/6均(+),腺上皮CK8/18和34βE12(+),肌上皮p63和SMA(+)。结论乳腺恶性腺肌上皮瘤罕见,预后差,与浸润性导管癌、化生性癌、肉瘤等多种肿瘤易混淆;应依据形态学特点、结合免疫组化结果鉴别。
Objective To investigate the pathomorphological features, diagnosis and differential diagnosis of malignant glandular myoepithelial neoplasm. Methods One case of malignant glandular myoepithelial neoplasm was analyzed by light microscopy and immunohistochemical staining, and the literature was reviewed. Results The tumor consisted of two kinds of malignant glandular epithelial cells and myoepithelial cells, which formed a nest mass infiltrating into the interstitial fibrosis. The cytoplasm of the gland epithelium was stained red and located in the center of the nests of the tumor cells. The epithelium was glandular. The myoepithelial epithelium Arranged in the periphery of the tumor cell nests, cytoplasm transparent, more common nuclear fission, cell shaped obvious. Immunohistochemistry showed bidirectional expression characteristics of both epithelial CK5 / 6 (+), gland epithelial CK8 / 18 and 34βE12 (+), myoepithelial p63 and SMA (+). Conclusions Breast malignant myoepithelioma is rare and has a poor prognosis. It may be confused with many kinds of tumors, such as invasive ductal carcinoma, metaplastic carcinoma and sarcoma. The morphological features and immunohistochemical results should be used to identify the malignant glandular myoepithelioma.